Provider Demographics
NPI:1316567316
Name:ENFOLD BH, LLC
Entity Type:Organization
Organization Name:ENFOLD BH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZERVOUDAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:954-254-6773
Mailing Address - Street 1:PO BOX 968
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27512-0968
Mailing Address - Country:US
Mailing Address - Phone:954-254-6773
Mailing Address - Fax:
Practice Address - Street 1:555 FAYETTEVILLE ST STE OFFICE50
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27601-3030
Practice Address - Country:US
Practice Address - Phone:954-254-6773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-20
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty